Drug reaction with eosinophilia and systemic symptoms in a cohort of Asian children

Abstract

Background/objectives: Drug reaction with eosinophilia and systemic symptoms (DRESS) is rare but potentially fatal in children. Fever and rash, which are salient features of DRESS, may mimic other commonly encountered pediatric conditions. We profiled the DRESS cases in a tertiary children's hospital in Singapore. Methods:The medical records of all pediatric DRESS patients diagnosed from 2006 to 2016. Data on epidemiology, inciting drugs, clinical, pathologic manifestations, and treatment were assessed.Results: Ten patients aged 4-16 years old were diagnosed with DRESS within the 10year period. Drugs implicated were antibiotics, such as trimethoprim-sulfamethoxazole, and anticonvulsants, such as carbamazepine, phenobarbitone, and levetiracetam. All patients had fever and pruritic exanthems. Desquamation, purpura, and oral mucositis were also observed. Lymphadenopathy, hepatomegaly, and facial edema occurred frequently. There was liver involvement in all cases, but none progressed to liver failure.Seven patients had eosinophilia, and nine had atypical lymphocytosis. Other laboratory abnormalities included low hemoglobin, thrombocytosis, and prolonged coagulation times. All patients received systemic corticosteroids of varying durations and dosages.

Drug rash with eosinophilia and systemic symptoms syndrome in an adolescent - efficiency of immunoglobulin G in a corticosteroid resistant case

“…In conclusion, we join the authors [6,[10][11][12][13][14][15][16][17][18]20] of who favor the treatment of DRESS sy using IVIG, and we point out to the need to change the order of recommendations in the current treatment recommendations for DRESS sy [5,9] in favor of IVIG. IVIG should be considered as a second-line treatment as soon as possible in patients in whom corticosteroid treatment failed.…”

“…Significant clinical, hematologic and biochemical improvement occurred the day after the first dose of IVIG ie. IVIG therapy was a life-saving in this case [10,11]. Actually, we started treatment according to RegiSCAR scoring [5] ie.…”

“…6/6 criterias for DRESS sy were established and according to this, the treatment was performed with a corticosteroid at a dose of 1g/kg body weight (methylprednisolone) intravenous (iv) for eight days with continued antihistamine (cetirizine was administered at twice the dose from the regular dose) as well as with the elimination diet, withdrawal of carbamazepine on day sixth of hospitalization and increased doses of Na-valproate at 1500mg/day. As the described clinical picture is maintained until the ninth day of hospitalization, and despite the eight days administration of methylprednisolone (iv), the treatment was continued with iv IgG (IVIG, human normal immunoglobulin for intravenous use), even though the indication was not justified by data from controlled clinical studies but based on case reports [10,11,12]. Two doses of IVIG were administered at 0.4 g/kg in eight-day intervals.…”

Drug reaction with eosinophilia and systemic symptoms (DRESS): A tertiary care centre retrospective study

“…7 Although there is no consensus on the actual medical treatment DRESS, it is widely accepted that systemic corticosteroids are the first line of treatment for these patients, but other treatments such as cyclosporin and biologics have also been used. [8][9][10] Given the paucity of information about this condition we conducted a retrospective cohort study of DRESS cases that presented to our centre in the past decade, with the objective to describe their clinical and laboratory characteristics, and clinical progress.…”

Critical Review of Gaps in the Diagnosis and Management of Drug-Induced Liver Injury Associated with Severe Cutaneous Adverse Reactions

“…Moreover, in DILI cases associated with cutaneous adverse drug reactions (ADRs), liver involvement is not usually accurately assessed when skin injuries are predominant and represent the first clinical manifestation, which is partially due to the lack of information regarding liver injury in the SCARs cohorts retrospectively analyzed [6][7][8][9][10][11][12][13][14].…”